title: Sunitinib treatment enabling resection of massive liver metastasis: a case report.
abstract: BACKGROUND
  Sunitinib was developed as a molecular-targeted drug to treat advanced renal cell carcinoma. It is not yet known whether liver damage occurs in patients with liver metastases of renal cell carcinoma after sunitinib administration. Here, we report the case of a patient with an inoperable massive liver metastasis of renal cell carcinoma for whom sunitinib administration was dramatically effective with no obvious evidence of liver damage. As a result, the liver metastasis could be resected. We emphasize the dramatic reduction in liver metastasis with sunitinib treatment, and the histopathological effects of sunitinib on the non-tumorous liver parenchyma.
  
  
  METHODS
  A 54-year-old Japanese woman was diagnosed with right renal cell carcinoma and underwent right nephrectomy 12 years earlier. She presented to a local clinic with right abdominal pain. A computed tomography scan showed a massive liver metastasis occupying her right hepatic lobe, and she was referred to our hospital for treatment. The diagnosis was not only liver metastasis, but also left renal metastasis. Oral administration of tyrosine kinase inhibitor sunitinib was started. Adverse events due to sunitinib included liver dysfunction, thrombocytopenia, and decreased hemoglobin, but she completed eight courses with the help of drug holidays and dose adjustments. Post-treatment computed tomography showed a dramatic reduction in size of her liver metastasis, enabling right lobectomy of her liver. Histopathological findings showed no obvious liver damage due to chemotherapy in non-cancerous parenchymal areas.
  
  
  CONCLUSIONS
  With the availability of sunitinib, some patients with potentially unresectable massive liver metastases of renal cell carcinoma may be able to undergo major hepatectomy curatively and safely with little histopathological damage to non-tumorous liver parenchyma, thus improving their prognosis.
authors.affiliation: Department of Surgery, Iwate Medical University School of Medicine, Morioka, Iwate 020-8505, Japan. takahara@iwate-med.ac.jp.
authors.forename: Shingo
authors.initials: S
authors.lastname: Mitomo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Takahara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nitta
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Fujita
authors.forename: Naoko
authors.initials: N
authors.lastname: Ito
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Uesugi
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Sugai
authors.forename: Go
authors.initials: G
authors.lastname: Wakabayashi